Does selective evaluation of gastric aspirates in preterm infants influence time to full enteral feeding?

The use of routine gastric aspiration in the assessment of feeding intolerance is widespread in neonatal practice. Our article seeks to answer the clinical question, 'In premature infants receiving feeds via nasogastric or orogastric tube [P], does routine evaluation of gastric aspirates [I] compared with selective evaluation of gastric aspirates [C] reduce the time taken to establish full feeds without complications [O]?' Articles were identified through MEDLINE and reference lists from the sources found were reviewed for additional publications. Three papers were critically appraised and National Health and Medical Research Centre grades of level of evidence have been assigned to each. We found limited evidence to either support or reject the practice of routine gastric aspiration in preterm infants. There were no increases in the rates of significant complications in studies underpowered for this outcome. The decision to perform routine or selective gastric aspiration should be determined by individual centres. A large scale randomised controlled trial would be of significant benefit in determining the value of routine gastric aspiration in preterm infants.

Does umbilical cord blood glucose extraction discriminate the risk of early neonatal hypoglycaemia in at-risk newborns?

AIM: Despite targeting newborns at risk of hypoglycaemia based on clinical characteristics, blood glucose measured at 1 and 4 h of age is frequently normal. Identification of at-risk newborns at the greatest risk of hypoglycaemia would allow more targeted, earlier intervention. We aimed to determine the ability of calculated umbilical cord blood glucose extraction to discriminate hypoglycaemia in at-risk newborns in the first 4 h of life. METHODS: Newborns with paired arterial and venous cord blood glucose and 1 ± 4 h capillary or venous blood glucose measured using a blood gas analyser (radiometer) were retrospectively identified (n = 154). Hypoglycaemia was defined as a blood glucose ≤2.0 mmol/L. The ability of calculated umbilical cord blood glucose extraction to discriminate risk of hypoglycaemia was determined by an receiver operating characteristic (ROC) curve. RESULTS: Twenty-seven newborns (18%) had a blood glucose ≤2.0 mmol/L at either time point. Neither arterial nor venous cord blood glucose predicted early hypoglycaemia better than chance. The area under the ROC curve for umbilical cord blood glucose extraction (area under the ROC curve = 0.74, (95% confidence interval, 0.65-0.82)) was significantly better than chance and arterial or venous cord blood glucose. An umbilical cord blood glucose extraction of 16% had the best sensitivity (80%) and specificity (55%) for discriminating the risk of early hypoglycaemia. CONCLUSIONS: Umbilical cord blood glucose extraction discriminates the risk of early hypoglycaemia at 1 or 4 h of age. However, the clinical utility of this test is limited due to the low sensitivity and specificity. Its predictive value may be greater in specific subsets of at-risk newborns and warrants further investigation.

LGBTQ+ Worker Protections: Implications for Academic Medicine Today and in the Future.

The Supreme Court's 2020 ruling prohibiting workplace discrimination based on sexual orientation or gender identity ( Bostock v Clayton County ) offers new legal protections for LGBTQ+ employees and allies and new opportunities for academic medicine to advance LGBTQ+ inclusion at their institutions. In this perspective piece, the authors examine the history of LGBTQ+ community recognition, tolerance, protections, and ongoing inclusion and the advocacy efforts led by LGBTQ+ patients, community activists, and medical colleagues. They also examine the current limitations of the court's ruling and recommend future actions to advance workplace and health equity. While recent advancements in equality have not erased chronic barriers to inclusion and advancement, they can pave the way for leaders in research, education, and clinical care to shape national health guidelines and policies that impact the health of all Americans.